Pulmonary endarterectomy (PEA) is the treatment of choice for patients with chronic thromboembolic pulmonary hypertension (PH), provided lesions are proximal enough in the pulmonary vasculature to be surgically accessible and the patient is well enough to benefit from the operation in the longer term. It is a major cardiothoracic operation, requiring specialized techniques and instruments developed over several decades to access and dissect out the intra-arterial fibrotic material. While in-hospital operative mortality is low (<5%), particularly in high-volume centers, careful perioperative management in the operating theater and intensive care is mandatory to balance ventricular performance, fluid balance, ventilation, and coagulation to avoid or treat complications. Reperfusion pulmonary edema, airway hemorrhage, and right ventricular failure are the most problematic complications, often requiring the use of extracorporeal membrane oxygenation to bridge to recovery. Successful PEA has been shown to improve both morbidity and mortality in large registries, with survival >70% at 10 years. For patients not suitable for PEA or with residual PH after PEA, balloon pulmonary angioplasty and/or PH medical therapy may prove beneficial. Here, we describe the indications for PEA, specific surgical and perioperative strategies, postoperative monitoring and management, and approaches for managing residual PH in the long term.

肺动脉内膜切除术 (PEA) 是慢性血栓栓塞性肺动脉高压 (PH) 患者的首选治疗方法，前提是病变距离肺血管系统足够近，可以通过手术到达，并且患者的健康状况足以从长期手术中受益。这是一项重大的心胸手术，需要几十年来开发的专门技术和仪器来接触和解剖动脉内纤维化物质。虽然院内手术死亡率较低（<5%），特别是在大容量中心，但必须在手术室和重症监护室进行仔细的围手术期管理，以平衡心室功能、体液平衡、通气和凝血，以避免或治疗并发症。再灌注肺水肿、气道出血和右心室衰竭是最严重的并发症，通常需要使用体外膜肺氧合才能恢复。大型登记显示，成功的 PEA 可以改善发病率和死亡率，10 年生存率 >70%。对于不适合 PEA 或 PEA 后仍有 PH 残留的患者，球囊肺血管成形术和/或 PH 药物治疗可能是有益的。在此，我们描述 PEA 的适应症、具体手术和围手术期策略、术后监测和管理以及长期管理残留 PH 的方法。